The Physician as Teacher: Final Reflections

When I began this selective, I was a senior medical student, nearing the end of my training. I had many tools in my tool belt: I could take a history, I could generate a differential diagnosis and a tolerable management plan; I even knew exactly what time of day I needed to plan to get coffee based on how many hours I slept the night before. I had learned the CanMeds roles and felt I could embody a physician beyond the medical expert, having learned to advocate, communicate, and collaborate effectively; I thought I was ready for residency. I was wrong.

The past month has been an opportunity for continuous reflection and learning, not only about myself, but about what it really means to be a doctor. In my blog posts I have tried to chronicle my journey of learning about how doctors learn, how we think, and how a curriculum might be best designed to capture this most effectively. The last week I took a bit of a 180 degree turn and spoke more about the Art of Medicine and how this might be effectively taught in the curriculum. Throughout this reading and reflective writing process, I have had the absolute pleasure of working with Dr. Ho Ping Kong in his clinic, absorbing (sometimes without realizing it) his fundamental lessons of compassion, integrity, connection, and humility. I have come to realize this month that there is a quality physicians should be cultivating which I feel is not encompassed by the CanMeds roles, and that is one of Teacher.

The physician as Teacher can be described in several dimensions. First, with our patients and their families: beyond communicating information, teaching is about bridging a gap in knowledge. It requires an ability to understand where the person you are teaching is standing, identifying their fears and confusion, and addressing all of these things while ensuring the information is provided in a way that will be understood and remembered. It requires compassion, patience, and empathy; effective teachers understand when somebody will not be able to hear and remember (i.e. when a relative is at death’s door, or they are in pain) and are sensitive to the changing landscape of a patient-doctor interaction.

Secondly, physicians are teachers of medical learners. Several schools have programs in their residency programs for ‘Teaching Residents to Teach’, and yet these are not mandatory programs. While it is true that not all physicians will make this a focus of their career, nearly all of us will contribute to the training of future doctors and have not been given the skills or tools to do this effectively. Many of the principles I have addressed in my blog posts about teaching and learning strategies, as well as topics I was not able to address including physician self-assessment and feedback are integral to effective teaching, and yet the majority of physicians know nothing about them. Again, in this case, beyond the technical knowledge and medical education principles, good teaching requires an increased ability for physicians to recognize their own abilities and the difference between them and their students before they can effectively bridge that knowledge gap.

By incorporating the physician as Teacher into a framework such as the CanMeds roles, it would be a mandated expectation for physicians to be competent in the fundamental areas which would allow physicians to be effective teachers. These include qualities I've highlighted in my previous posts about critical consciousness and self-awareness, as well as an ability for physicians to practice reflective medicine and accurately evaluate their own abilities and shortcomings. It also would encourage many of the qualities of empathy, humility, and compassion - essentially embodying the Art of Medicine – which, before now, have nowhere been included in the core competencies of physicians, despite it being the unwritten expectation for all of us to develop these skills.

Many of these ideas of physician as teacher have been inspired by Dr. Ho Ping Kong, who is arguably the best teacher of medicine I have encountered in my four years of medical school. When I think of the kind of physician I would like to be in future, I think first of teaching; when I think of teaching in future, I will inevitably think of Dr HPK. Certainly he embodies the skills and strengths described by the original CanMeds roles: he advocates tirelessly for his patients, is an excellent communicator, and continues to advance his medical knowledge despite having been in practice for close to fifty years. But there is a quality to Dr HPK that is unique and goes beyond all of these traits to work a sort of magic, and that is his teaching ability, visible not only to patients but to his countless students over the years.

And so, I feel that at the beginning of this selective I was a medical student, but I have come out the other side a Doctor. A doctor who is ready to begin residency training in pediatrics, buoyed by the support and training of many physicians over the last four years, but truly shaped by individual teachers who have modeled for me the art of medicine and instilled in me qualities beyond the CanMeds competencies. I have always wanted to be a teacher, but this past month crystallized for me what being a teacher truly means. It has inspired me to seek out more opportunities for practicing my own budding teaching skills, to continue to develop a critical consciousness, and to embrace self-reflection and self-awareness. Though they are incredibly large shoes to fill, I hope to become a teacher of medicine, a doctor, like Dr. Ho Ping Kong; and a mentor to other students as he has become for me.

~LG